基于循证的集束化干预策略在ICU多重耐药菌感染控制中的应用研究

Application of the evidence-based bundle intervention strategy in ICU infection control of multidrug-resistant bacteria

目的评估集束化干预策略在重症监护病房多重耐药菌感染控制中的应用效果。方法分析某省三级甲等中医院重症监护病房实施集束化干预策略前(2019年1-12月)与实施后(2020年1-12月)多重耐药菌感染预防控制效果。结果实施后多重耐药菌医院感染发生率由9.76%降至2.44%(P<0.05);高频接触表面及仪器表面清洁消毒效果合格率由61.79%提高至77.37%(P<0.05);医生、护士和护工手卫生依从率在接触患者前、清洁/无菌操作前、接触患者体液后、接触患者后、接触患者的周围环境后5个方面均显著高于实施前(P<0.05);多重耐药菌患者平均住院日、日平均费用有明显下降趋势(P<0.05)。结论实施集束化干预策略能有效降低多重耐药菌医院感染发生率,提高高频接触表面及仪器表面的清洁消毒效果,提高医务人员手卫生依从率,降低患者平均费用及平均住院日数。

Objective To evaluate the application effect of the bundle intervention strategy in the control of multidrug-resistant bacterial infection in intensive care units.Methods The prevention and control effects of multidrug-resistant bacteria infection were analyzed before and after the implementation of the bundle intervention strategy in intensive care units of a grade A hospital of Chinese medicine in a province.Results After the implementation of the strategy,the incidence of multidrug-resistant bacteria infection was decreased from 9.76%to 2.44%(P<0.05),and the qualified rate of cleaning and disinfection effect of high-frequency contact surfaces and instrument surfaces was increased from 61.79%to 77.37%(P<0.05).The hand hygiene compliance rates of doctors,nurses and nursing workers were significantly higher than those before the strategy implementation in the following five aspects:before contact with patients,before cleaning/aseptic operation,after contact with patients’body fluids,after contact with patients,and after contact with patients’surrounding environment(P<0.05).The average hospitalization days and average daily expenses of patients with multidrug-resistant bacteria showed a significant downward trend(P<0.05).Conclusion The bundle intervention strategy can effectively reduce the incidence of multidrug-resistant bacteria in hospital,improve the cleaning and disinfection effect of high-touch surfaces and instrument surfaces,improve the hand hygiene compliance rate of medical staff’s,and reduce the average cost and average length of hospital stay.